Healthcare Provider Details

I. General information

NPI: 1639315880
Provider Name (Legal Business Name): UENO CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 ALA MOANA BLVD ILIKAI HOTEL LOBBY LEVEL
HONOLULU HI
96815-1603
US

IV. Provider business mailing address

1777 ALA MOANA BLVD ILIKAI HOTEL LOBBY LEVEL
HONOLULU HI
96815-1603
US

V. Phone/Fax

Practice location:
  • Phone: 808-926-9911
  • Fax: 808-983-3919
Mailing address:
  • Phone: 808-926-9911
  • Fax: 808-983-3919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number1578
License Number StateHI

VIII. Authorized Official

Name: DR. GEORGE SHIMOMURA
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 808-926-9911